Healthcare Provider Details

I. General information

NPI: 1083505861
Provider Name (Legal Business Name): COMPASSIONATE RECOVERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 KENDRA CT STE 102
LOS ANGELES CA
90068-3846
US

IV. Provider business mailing address

2023 KENDRA CT
LOS ANGELES CA
90068-3846
US

V. Phone/Fax

Practice location:
  • Phone: 310-266-3774
  • Fax:
Mailing address:
  • Phone: 310-266-3774
  • Fax: 323-380-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN PETERSON
Title or Position: CEO
Credential: MD
Phone: 310-266-3774